By Mark J. Ingerman, MD, FACP, chief, Infectious Diseases and Infection Prevention, MLH
Three major outbreaks are occurring throughout the U.S. in the beginning of 2019. Yearly influenza continues at a moderate to high level in the local area. The prominent viral strain has changed from H1N1 to H3N2, which is associated with a high morbidity and mortality in the elderly population. Please remain vigilant regarding the diagnosis and treatment of your patients with potential influenza. In addition, as a healthcare provider, if you experience signs and symptoms of influenza, please seek medical attention and do not enter a MLHS facility.
The second outbreak is associated with the viral infection of mumps. From 1/1/19 to 2/28/19, 30 States have reported infections in at least 151 people to the CDC. Prior to 1967, before the mumps vaccination program started, about 186,000 cases were reported yearly. However, the actual number of cases was likely much higher due to underreporting. In 1989 two doses of the MMR (measles, mumps rubella) vaccination program was introduced in the US. Mumps cases decreased by more than 99%. However, due to lack of compliance with vaccination programs and potential waning immunity of the mumps component of MMR, this infection has resurfaced in the US. In the local area, there has been an outbreak at Temple University. A mass vaccination program of about 5,000 individuals with a third dose of MMR has occurred. Dr. Kumar and Dr. Ingerman have contacted the Department of Health in both Philadelphia and Montgomery Counties. It has been confirmed at present, there is no community outbreak of mumps in our local region. Furthermore, at present there is no recommendation at this time to offer MLH employees or caregivers a third MMR vaccination. This also aligns with CDC guidance. Should we face an institutional or local community outbreak, this recommendation may change.
For now, all employees should observe the appropriate personal protective equipment as we provide care to patients in the community.
The outbreak of mumps have most commonly occurred in persons who have prolonged, close contact such as sharing water bottles, kissing, practicing sports together, or living in close quarters with a person who has mumps.
Mumps is a contagious disease that starts with fever, headaches, muscle aches, fatigue and loss of appetite. Most people will have swelling of their salivary glands, puffy cheeks and a tender swollen jaw.
Complications of mumps include:
- Inflammation of testes (orchitis in males)
- Inflammation of ovaries (oophoritis)
- Mastitis (inflammation of the breasts)
- Pancreatitis (inflammation of the pancreas)
- Inflammation of the brain (encephalitis or meningitis)
There has been a resurgence of measles infections, a disease that was reported to be eradicated in the U.S. in the year 2000. From 1/1/19 to 3/3/19, 387 cases have been confirmed in 15 States. This is the second largest number of cases reported in the U.S. since it was eradicated in the year 2000. Unlike in the case of mumps where cases occurred in patients who are appropriately vaccinated with MMR, cases of measles have occurred mainly in those patients who have been unvaccinated. The most common scenario is an unvaccinated person who travels to a foreign country and acquire this highly contagious viral infection, returns to the U.S., and infects individuals who have no immunity because of their lack of vaccine status. Approximately nine out of ten susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles can remain infectious in the air for up to two hours after the person leaves an area
Measles is an acute viral respiratory illness typically characterized by fever, malaise, cough, coryza, and conjunctivitis, followed by a maculopapular rash. The rash appears about 14 days after exposure and moves from the head to the trunk to the lower extremities. Patients are considered highly contagious from four days before to four days after a rash appears. This is one of the most contagious infections that we deal with in infectious diseases. Complications include:
- Otitis media
- Pulmonary infections
- One out of every 1,000 measles cases will develop acute encephalitis resulting in permanent brain damage.
- One to two out of every 1,000 children will die from respiratory and neurological complications.
- Subacute sclerosing panencephalitis (SSPE) is a rare but fatal degenerative disease of the central nervous system that generally develops seven to ten years after measles infection.
People at risk for severe illness and complications include infants and children less than five years, adults age greater than 20 years, pregnant women, and people with compromised immune systems. The only way to prevent measles infection is to be properly vaccinated with two MMR vaccines if you were born after 1957. Those people born before 1957 are considered immune as they likely had natural infection.